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EVENING CITYSCAPES IN LONDON

The Southbank, London..Photo: Tom Pietrasik.London, UK.April 2013. (Tom Pietrasik)Dusk descends over the concrete expanse of London’s Southbank arts centre. London, U.K. ©Tom Pietrasik 2013


Its that time of year in Europe when the days grow longer, summer beckons and the hours of dusk seem to last an eternity. When I lived in India, spring was a season to dread, notable for the onset of those sweaty evenings when darkness can no longer be relied upon to bring relief from the heat. In stark contrast, the urban landscape of central London inspires a sense of anticipation and of hope: a time to savour the long evenings and with it the promise of summer.

London scenes. ..Photo: Tom Pietrasik.London, U.K..May 2011 (Tom Pietrasik)Day turns slowly to night across the urban landscape of the City of London, Britain’s financial capital. London, U.K. ©Tom Pietrasik 2011
London scenes...Photo: Tom Pietrasik.London, U.K..May 21st 2011 (Tom Pietrasik)Evening view from a bar as clouds gather. London, U.K. ©Tom Pietrasik 2011
The Southbank, London..Photo: Tom Pietrasik.London, UK.April 2013. (Tom Pietrasik)The subterranean landscape of London’s Southbank arts complex. London, U.K. ©Tom Pietrasik 2013

BIG PHARMA, GENERIC DRUGS & LIVING WITH HIV

Vasanti Shinde, age 26, who is HIV positive, at home with her daughters Vrinda, 8 and Shruda, 10. Shinde works for the Save Foundation which represents the rights of HIV positive people. ...Like many of the women who work for and with the Save Foundation, Vasanti Shinde, age 26, only found out that she was HIV positive after her husband became seriously ill with an AIDS-related illness five years ago. Vasanti's husband subsequently died. Vasanti now lives with her two younger daughters Shrudha, age 10, and Vrinda, 8, in the one-room home of her brother in Sangli city. Vasanti's elder daughter, eleven year old Shubhada is being brought up by her paternal grandmother and sees her mother during holidays. Vasanti knows that Shubhada is HIV negative and Shruda is positive but anxiety over the result means that she refuses to have Vrinda tested for HIV. For a monthly income of Rs.3500, Vasanti works as a field officer and counselor for the Save Foundation. She works in the positive-people's pharmacy for no pay. Her work with the Save Foundation entitles her access to a credit union which provides low interest loans covering medical expenses. Though first-line drugs and homeopathic medicine keep Vasanti healthy, she is prone to infection and recently suffered a bout of influenza. Vasanti is completely open about her HIV status and most of her neighbours know that she is HIV positive. Vasanti says that "I used to feel like I was going to die. Now, because of the Save Foundation, I feel like I'm going to live." ..Photo: Tom Pietrasik.Sangli, Maharashtra. India.August 28th 2008. (Tom Pietrasik)Vasanti Shinde, at home with two of her daughters Vrinda, 8 and Shruda, 10. Maharashtra. India ©Tom Pietrasik 2008

The struggle against the over-zealous patenting of life-saving drugs was dealt a victory in India last week. So it seemed an appropriate time to revisit my photographs, commissioned by UNDP, of Vasanti Shinde, an HIV-positive mother of three girls.

Like many Indian women living with HIV, 26 year-old Vasanti only discovered she was infected by the virus when her husband became seriously ill and subsequently died.

In Samdoli village, 10km from Sangli city, the Shramsafayla Self Help Group of HIV positive and non HIV women meet for a monthly session. They share advice on income generating activities. Each woman contributes Rs.30 a month to a credit fund. The group has been meeting for 18 months.  Like many of the women who work for and with UNDP partners the Save Foundation, Vasanti Shinde, age 26, only found out that she was HIV positive after her husband became seriously ill with an AIDS-related illness five years ago. Vasanti's husband subsequently died. Vasanti now lives with her two younger daughters Shrudha, age 10, and Vrinda, 8, in the one-room home of her brother in Sangli city. Vasanti's elder daughter, eleven year old Shubhada is being brought up by her paternal grandmother and sees her mother during holidays. Vasanti knows that Shubhada is HIV negative and Shruda is positive but anxiety over the result means that she refuses to have Vrinda tested for HIV. For a monthly income of Rs.3500, Vasanti works as a field officer and counselor for the Save Foundation. She works in the positive-people's pharmacy for no pay. Her work with the Save Foundation entitles her access to a credit union which provides low interest loans covering medical expenses. Though first-line drugs and homeopathic medicine keep Vasanti healthy, she is prone to infection and recently suffered a bout of influenza. Vasanti is completely open about her HIV status and most of her neighbours know that she is HIV positive. Vasanti says that "I used to feel like I was going to die. Now, because of the Save Foundation, I feel like I'm going to live."  Photo: Tom Pietrasik Sangli, Maharashtra. India August 29th 2008 (Tom Pietrasik)Vasanti Shinde prepares for a monthly self-help group meeting of HIV positive and non HIV women close to her home. Maharashtra. India ©Tom Pietrasik 2008

Before meeting her, I might have expected Vasanti to be irrevocably branded by the stigma that burdens so many HIV-positive Indians. But quite the reverse. By accepting and confronting her disease, Vasanti had succeeded in transforming her life for the better. She had become an outspoken advocate for the rights of HIV-positive people working with a local organisation called the Save Foundation that was affiliated to a wider national-network HIV-positive groups.

I thought of Vasanti last week when the Indian Supreme Court finally rejected a patent application by Swiss Drug company Novartis for its cancer drug Glivec (Gleevec). This ruling prioritises the rights of all those who rely on generic drugs, whether for the treatment of cancer or for other conditions including HIV/AIDS.

Generic drugs are sold at a fraction of the cost of branded equivalents and had Novartis seen victory last week, they and other “Big Pharma” would have undoubtedly stepped up their assault on India’s generic drug industry which, according to Leïla Bodeux of Oxfam, supplies “Eighty per cent of medicines used to treat HIV in the developing world.”

At home Vasanti (centre) and daughters Shrudha, 10 (HIV positive, in pink), Shubhada, 11 (HIV negative, foreground) and Vrinda, 8 (status not known). Vasanti Shinde, 26, works for the Save Foundation.  Like many of the women who work for and with UNDP partners the Save Foundation, Vasanti Shinde, age 26, only found out that she was HIV positive after her husband became seriously ill with an AIDS-related illness five years ago. Vasanti's husband subsequently died. Vasanti now lives with her two younger daughters Shrudha, age 10, and Vrinda, 8, in the one-room home of her brother in Sangli city. Vasanti's elder daughter, eleven year old Shubhada is being brought up by her paternal grandmother and sees her mother during holidays. Vasanti knows that Shubhada is HIV negative and Shruda is positive but anxiety over the result means that she refuses to have Vrinda tested for HIV. For a monthly income of Rs.3500, Vasanti works as a field officer and counselor for the Save Foundation. She works in the positive-people's pharmacy for no pay. Her work with the Save Foundation entitles her access to a credit union which provides low interest loans covering medical expenses. Though first-line drugs and homeopathic medicine keep Vasanti healthy, she is prone to infection and recently suffered a bout of influenza. Vasanti is completely open about her HIV status and most of her neighbours know that she is HIV positive. Vasanti says that "I used to feel like I was going to die. Now, because of the Save Foundation, I feel like I'm going to live."  Photo: Tom Pietrasik Sangli, Maharashtra. India August 28th 2008 (Tom Pietrasik)Vasanti Shinde, at home with her daughters Vrinda, 8 and Shruda, 10 and Shubhada, 11.  Maharashtra. India ©Tom Pietrasik 2008

Agencies like UNDP have questioned whether laws to protect patents are compatible with the human rights of those who require access to essential drugs. And senior scientists (many trained at public-expense) including Brian Druker, the key researcher behind Glivec, have expressed discomfort when companies like Novartis attempt to extend their monopolies on drugs developed by a “collaborative and open process of innovation, where both the private and public sectors play an indispensable role.” Joseph E. Stiglitz and Arjun Jayadev warn that there is a cost to bear for strong patent protection:

“… higher prices for consumers, the dampening effect on further innovation of reducing access to knowledge, and, in the case of life-saving drugs, death for all who are unable to afford the innovation that could have saved them.”

Vasanti with her youngest daughter Vrinda after collecting her from school in Sangli. ..Like many of the women who work for and with UNDP partners the Save Foundation, Vasanti Shinde only found out that she was HIV positive after her husband became seriously ill with an AIDS-related illness five years ago. Vasanti's husband subsequently died. Vasanti now lives with her two younger daughters Shrudha, age 10, and Vrinda, 8, in the one-room home of her brother in Sangli city. Vasanti's elder daughter, eleven year old Shubhada is being brought up by her paternal grandmother and sees her mother during holidays. Vasanti knows that Shubhada is HIV negative and Shruda is positive but anxiety over the result means that she refuses to have Vrinda tested for HIV. For a monthly income of Rs.3500, Vasanti works as a field officer and counselor for the Save Foundation. She works in the positive-people's pharmacy for no pay. Her work with the Save Foundation entitles her access to a credit union which provides low interest loans covering medical expenses. Though first-line drugs and homeopathic medicine keep Vasanti healthy, she is prone to infection and recently suffered a bout of influenza. Vasanti is completely open about her HIV status and most of her neighbours know that she is HIV positive. Vasanti says that "I used to feel like I was going to die. Now, because of the Save Foundation, I feel like I'm going to live." ..Photo: Tom Pietrasik.Sangli, Maharashtra. India.August 27th 2008. (Tom Pietrasik)Vasanti Shinde, walks home with her youngest daughter Vrinda, 8. Maharashtra. India ©Tom Pietrasik 2008

A shared sense of solidarity with other HIV-positive Indians meant that Vasanti’s advocacy work had allowed her to breach the intransigent barriers of caste, religion and language that divide Indian society. Like many other advocates for the HIV-positive community, Vasanti’s horizons had broadened and she had outspoken opinions on subjects beyond the immediate concerns of her illness. Indeed, her own experience of discrimination had led her to consider the concerns of others condemned by prejudice and ignorance for reasons that had nothing to do with HIV.

HIV positive women from the Save Foundation prepare to perform their play on the issue of HIV discrimination to an audience in Samodoli village. Like many of the women who work for and with UNDP partners the Save Foundation, Vasanti Shinde, age 26, only found out that she was HIV positive after her husband became seriously ill with an AIDS-related illness five years ago. Vasanti's husband subsequently died. Vasanti now lives with her two younger daughters Shrudha, age 10, and Vrinda, 8, in the one-room home of her brother in Sangli city. Vasanti's elder daughter, eleven year old Shubhada is being brought up by her paternal grandmother and sees her mother during holidays. Vasanti knows that Shubhada is HIV negative and Shruda is positive but anxiety over the result means that she refuses to have Vrinda tested for HIV. For a monthly income of Rs.3500, Vasanti works as a field officer and counselor for the Save Foundation. She works in the positive-people's pharmacy for no pay. Her work with the Save Foundation entitles her access to a credit union which provides low interest loans covering medical expenses. Though first-line drugs and homeopathic medicine keep Vasanti healthy, she is prone to infection and recently suffered a bout of influenza. Vasanti is completely open about her HIV status and most of her neighbours know that she is HIV positive. Vasanti says that "I used to feel like I was going to die. Now, because of the Save Foundation, I feel like I'm going to live."  Photo: Tom Pietrasik Sangli, Maharashtra. India August 29th 2008 (Tom Pietrasik)HIV positive women including Vasanti Shinde prepare to perform a play on the issue of HIV discrimination to an audience in Samodoli village. Maharashtra. India ©Tom Pietrasik 2008

Despite her resolve, Vasanti’s life bringing up three children on a modest income was still a struggle and not long before these photographs were taken she had suffered a bout of influenza. Vasanti was also torn by a dilemma. Of her eldest two children, one was HIV-positive, the other negative. But Vasanti could not bring herself to have her youngest daughter tested for HIV, desperate to avoid the inevitable heartbreak should the child test positive.

As I observed, here was a life being lived to its fullest by a woman who could look forward to the prospect of seeing her children grow up because she had access to life-saving generic drugs that would otherwise be beyond her means. Countless versions of Vasanti’s story of dignity and hope are played out across the Developing World by people who, like her, will be thankful that last week the Indian Supreme Court placed their needs above those of a multinational drug company.

You can see more of my photographs of Vasanti here.

At home, Vasanti's  HIV positive daughter Shruda, 10. Vasanti Shinde, 26, works for the Save Foundation.  Like many of the women who work for and with UNDP partners the Save Foundation, Vasanti Shinde, age 26, only found out that she was HIV positive after her husband became seriously ill with an AIDS-related illness five years ago. Vasanti's husband subsequently died. Vasanti now lives with her two younger daughters Shrudha, age 10, and Vrinda, 8, in the one-room home of her brother in Sangli city. Vasanti's elder daughter, eleven year old Shubhada is being brought up by her paternal grandmother and sees her mother during holidays. Vasanti knows that Shubhada is HIV negative and Shruda is positive but anxiety over the result means that she refuses to have Vrinda tested for HIV. For a monthly income of Rs.3500, Vasanti works as a field officer and counselor for the Save Foundation. She works in the positive-people's pharmacy for no pay. Her work with the Save Foundation entitles her access to a credit union which provides low interest loans covering medical expenses. Though first-line drugs and homeopathic medicine keep Vasanti healthy, she is prone to infection and recently suffered a bout of influenza. Vasanti is completely open about her HIV status and most of her neighbours know that she is HIV positive. Vasanti says that "I used to feel like I was going to die. Now, because of the Save Foundation, I feel like I'm going to live."  Photo: Tom Pietrasik Sangli, Maharashtra. India August 28th 2008 (Tom Pietrasik)Vasanti Shinde’s daughter Shruda, age 10, at home. Maharashtra. India ©Tom Pietrasik 2008

INDIAN FARMER DOUBLES RICE-YIELD

Two weeks ago the story of an Indian rice farmer attracted much attention in the Guardian. John Vidal described the experience of Sumant Kumar from Bihar who saw a hectare of his land yield 22.4 tonnes of rice – over four times the norm. Kumar had achieved this incredible output by the use of a little-known organic method called SRI or System of Rice Intensification.

Kumar’s experience resonated with me because in November last year Oxfam asked me to document the very same SRI technique, this time employed by farmers in Chhattisharh state. I travelled to a village called Rathkhandi and made a short film about the experiences of a farmer called Amar Singh Patel whose use of SRI has seen his rice-yield double. You can see the film above and the Guardian now features the film on their website.

 Amar Singh Patel and his wife, Sona Bai on their plot of SRI cultivated rice, two weeks before harvest. ..Amar Singh Patel, age 60 owns owns 5 acres of land, 1.5 of which is irrigated. He lives in Rathkhandi village, Bilaspur District, Chhattisgarh State with his wife Sona Bai, their daughter and son-in-law and four grandchildren...On this irrigated land, Amar Singh's family cultivate rice using the SRI technique together with a small vegetable plot. The remaining 3.5 acres are leased out to share-croppers. Amar Singh was introduced to SRI by Oxfam partners Jan Swasthya Sahyog (JSS) and began growing rice using this technique in 2007...Amar Singh's land did not always produce enough food for his family to eat. When Amar Singh was a young man, he and his family had to eat wild flowers to survive. They also had to sell their cattle, buy clothing on credit and migrate in search of work...The JSS introduced SRI to Amar Singh and others in his village. SRI is an organic system of intensively growing rice that can double crop yields double. ..Using SRI, Amar Singh and his family produce enough rice for all of their annual needs from only 1.5 acres of land. They now never go hungry...By using SRI Amar Singh never has to spend money on expensive chemicals which degrade the soil. SRI also uses less seed. With fewer inputs Amar Singh has made savings and invested these in his farm. Last year he purchased a new bullock cart. And Amar Singh's grandchildren no longer have to work the land when they should be at school as he did when he was a child. ..The JSS have recruited Amar Singh to advocate for SRI and teach other farmers the benefits of this system of agriculture. ..Photo: Tom Pietrasik.Chhattisgarh, India.November 2012 (Tom Pietrasik)Farmers Amar Singh and Sona Bai Patel survey their crop of SRI rice. Chhattisgarh. India ©Tom Pietrasik 2012

Amar Singh was trained in SRI cultivation by public health project Jan Swasthya Sayhog (JSS). I have photographed, filmed and written about the JSS’ wonderful work before and SRI-training is just one of the many strategies they employ to help improve health outcomes among the people they serve.

Accompanying me on my trip to Rathkhandi was SRI-advocate Jacob Nellithanam who explained to me that, despite well-documented evidence attesting to the efficacy of SRI, the technique is only now beginning to attract the kind of widespread interest it deserves.

Unlike conventional farming practice that promotes the use of GMO (Genetically Modified Organisms), fertilisers and pesticides, SRI cultivation offers few opportunities for outside interests to make any money. Indeed, by providing an alternative with improved outcomes, SRI challenges the very need for the inputs that are the mainstay of the chemical and biotech industries. It is of course SRI’s inability to deliver profits to anyone but the farmer that may help explain just why so few people have heard of it.

 Amar Singh Patel (right) outside the family home with his wife, Sona Bai; and  grandaughter, Jaymati (age 11)...Amar Singh Patel, age 60 owns owns 5 acres of land, 1.5 of which is irrigated. He lives in Rathkhandi village, Bilaspur District, Chhattisgarh State with his wife Sona Bai, their daughter and son-in-law and four grandchildren...On this irrigated land, Amar Singh's family cultivate rice using the SRI technique together with a small vegetable plot. The remaining 3.5 acres are leased out to share-croppers. Amar Singh was introduced to SRI by Oxfam partners Jan Swasthya Sahyog (JSS) and began growing rice using this technique in 2007...Amar Singh's land did not always produce enough food for his family to eat. When Amar Singh was a young man, he and his family had to eat wild flowers to survive. They also had to sell their cattle, buy clothing on credit and migrate in search of work...The JSS introduced SRI to Amar Singh and others in his village. SRI is an organic system of intensively growing rice that can double crop yields double. ..Using SRI, Amar Singh and his family produce enough rice for all of their annual needs from only 1.5 acres of land. They now never go hungry...By using SRI Amar Singh never has to spend money on expensive chemicals which degrade the soil. SRI also uses less seed. With fewer inputs Amar Singh has made savings and invested these in his farm. Last year he purchased a new bullock cart. And Amar Singh's grandchildren no longer have to work the land when they should be at school as he did when he was a child. ..The JSS have recruited Amar Singh to advocate for SRI and teach other farmers the benefits of this system of agriculture. ..Photo: Tom Pietrasik.Chhattisgarh, India.November 2012 (Tom Pietrasik)Farmers Sona Bai and Amar Singh Patel at home with their grand-daughter Jaymati. Chhattisgarh. India ©Tom Pietrasik 2012

SRI involves a farmer providing the ideal environment by which a seed can meet it’s full genetic potential. Research over the last 30 years shows that optimum conditions are achieved when the soil is aerated and nourished with organic matter. Sufficient spacing must be provided between plants, the land should not be flooded and must be regularly weeded. As Norman Uphoff who has led research on SRI from Cornell University explains, by such apparently simple methods not only is the plant itself nurtured but so too are the thousands of species that live in on and around it and contribute to it’s vitality.

If the experience of Amar Singh is typical, then SRI has the potential to provide food for millions who would otherwise go hungry and in the process dispel the need for chemical inputs and GMO, both of which carry risks.

The implications for rural communities in the Developing World are huge and have repercussions that go beyond the supply of food.

As a child, Amar Singh used to miss school to help on the family farm; his grandchildren never work the land when they should be studying. As a young man, Amar Singh used to have to migrate in search of work; his children do not. And fewer chemical inputs have allowed Amar Singh to make savings which he has invested in his farm, purchasing equipment and livestock and in the process benefiting the local economy.

Amar Singh Patel (red shirt) and his family on their plot of irrigated land. L to R: son-in-law, Santaram; daughter, Bahura Bai; wife, Sona Bai; grandson, Limesh (age 4); Amar Singh Patel; grandaughter, Jaymati (age 11)...Amar Singh Patel, age 60 owns owns 5 acres of land, 1.5 of which is irrigated. He lives in Rathkhandi village, Bilaspur District, Chhattisgarh State with his wife Sona Bai, their daughter and son-in-law and four grandchildren...On this irrigated land, Amar Singh's family cultivate rice using the SRI technique together with a small vegetable plot. The remaining 3.5 acres are leased out to share-croppers. Amar Singh was introduced to SRI by Oxfam partners Jan Swasthya Sahyog (JSS) and began growing rice using this technique in 2007...Amar Singh's land did not always produce enough food for his family to eat. When Amar Singh was a young man, he and his family had to eat wild flowers to survive. They also had to sell their cattle, buy clothing on credit and migrate in search of work...The JSS introduced SRI to Amar Singh and others in his village. SRI is an organic system of intensively growing rice that can double crop yields double. ..Using SRI, Amar Singh and his family produce enough rice for all of their annual needs from only 1.5 acres of land. They now never go hungry...By using SRI Amar Singh never has to spend money on expensive chemicals which degrade the soil. SRI also uses less seed. With fewer inputs Amar Singh has made savings and invested these in his farm. Last year he purchased a new bullock cart. And Amar Singh's grandchildren no longer have to work the land when they should be at school as he did when he was a child. ..The JSS have recruited Amar Singh as an advocate for SRI and teach other farmers the benefits of this system of agriculture. ..Photo: Tom Pietrasik.Chhattisgarh, India.November 2012 (Tom Pietrasik)Farmer Amar Singh Patel (in red) and his family at the farm on which they grow SRI rice. Chhattisgarh. India ©Tom Pietrasik 2012

TWO INDIAS EXIST IN HEALTHCARE

The Guardian website now features a short film I made about a health project in rural India called Jan Swasthya Sayhog (JSS).

I have photographed the JSS several times before and always felt that their ceaseless commitment to the rural community they serve together with their understanding of healthcare in India would warrant the making of a film. In producing this film, I also hope to provide some insight into the systemic deficiencies of healthcare in India.

Dr. Yogesh Jain with a TB patient during a weekly out-patient clinic at the JSS outreach medical centre in Bamhni village...The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access to essential services has been undermined by the Chhattisgarh government's decision to completely disinvest in public transport. ..Continually exposed to illnesses associated with malnutrition and poverty including tuberculosis and rheumatic heart disease, the doctors at JSS are tireless advocates for universal healthcare and the need to introduce measures to reduce society's inequities and fo (Tom Pietrasik, Tom Pietrasik)Dhanga Baiga, attended to by Dr Yogesh Jain of the Jan Swasthya Sahyog at a weekly clinic held in Bamhni village. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

Any honest discussion on the subject of medical care in India must acknowledge the government’s failure to properly resource the public healthcare system. India’s Economy grew almost 50% between 2001-2006 yet in the same period the malnutrition rate for under 3′s dropped just a single percentage point to 46%. When they entered power in 2004, the Congress-Party-led government promised to increase public health spending from 1% of GDP to 2-3% of GDP by 2012. Today, public spending on health stands at just 1.2% of GDP (the global average is 6.5%) and the Indian government, still led by the Congress Party, appears to have abandoned any notion of universal healthcare.

Without a properly-funded public healthcare system, those who have the resources to pay out of pocket or who are fortunate enough to possess health insurance, look to private hospitals for care. These hospitals in-turn attract the most able health professionals, drawing them away from and so further undermining the public system on which the majority of the population depend.

The husband (2nd left) of a 30-year old woman who had attempted suicide looks on anxiously as she is transported by ambulance from the JSS hospital in Ganiyari to the ICU at the large government hospital in Bilaspur, 25km away. The woman is one of many such cases of attempted suicide by the ingestion of insecticide. She was brought to the JSS hospital on a motorbike where doctors spent two hours stabilising her. The woman survived thanks to the efforts of the JSS and was discharged from hospital one week later. ..The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access t (Tom Pietrasik)The husband (2nd left) of a 30-year old woman who had attempted suicide looks on anxiously as she is transported by ambulance from the JSS hospital in Ganiyari to the ICU at the large government hospital in Bilaspur, 25km away. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010
While working for UNICEF in October, this phenomenon was illustrated to me by a doctor whom I was photographing as he and his medical team responded to an outbreak of measles in eastern Bihar. He told me that the remote district in which he was posted was unable to attract the doctors required to run local government health services. The problem was so bad that 70% of positions were left unfilled.

Doctors simply don’t want to be posted in a poor, far-off district that offers little opportunity to supplement a government wage with a private practice. The result is that the ordinary people in these areas must either forgo care or turn to unqualified quacks when they fall ill. The need is so great that the first-class service offered by a relatively small rural hospital like the JSS serves a catchment area comprising a population of almost 1 million people.

India’s failure to properly invest in a decent universal healthcare service compounds the widespread poverty and hunger that afflicts much of the population, 40% of whom are underweight. The World Health Organisation (WHO) describes public health spending in India as,

“abysmally low in a country where about 26% of people living below poverty line are critically dependent on public health services and the range and complexities of health issues are substantial with the equal presence of both communicable and non-communicable diseases.”

Dr. Raman Kataria reviews an x-ray on the ward of the JSS hospital in Ganiyari. Kataria is a specialist in pediatric surgery...The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access to essential services has been undermined by the Chhattisgarh government's decision to completely disinvest in public transport. ..Continually exposed to illnesses associated with malnutrition and poverty including tuberculosis and rheumatic heart disease, the doctors at JSS are tireless advocates for universal healthcare and the need to introduce measures to reduce society's inequities and (Tom Pietrasik)Pediatric surgeon Dr. Raman Kataria reviews the x-ray of a child on the ward of the JSS hospital in Ganiyari. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

Poverty, in all its manifestations, affects just about everyone who accesses the service provided by the JSS. When I visited the JSS hospital in Chhattisgarh in November, a young man, only recently married, was rushed to the emergency room with 40% burns. Like nine out of ten Indian workers, he was employed in what is called the un-organised sector where exploitation is routine and many workers undertake hazardous tasks with little or no regard to health and safety standards. On this occassion the young man had been casually employed to fix wires on top of an electricity pole even though he was not qualified to do so. While working, he received an electric shock and fell 8 meters unconscious to the ground. By the time he arrived at the JSS hospital, the doctors could detect widespread internal burning by the smell of the poor man’s body. He died the following day.

When the determinants of health, whether nutrition, clean water, adequate shelter or safe working conditions are compromised, it is surely even more incumbent on the Indian government to provide a properly resourced universal healthcare service.

You can find out more about the JSS on their website and read more about my experiences photographing them and their work here.

Empty syringes lie beside the foot of a 30-year old woman experiencing seizures after attempting suicide by drinking insecticide. The woman is one of many such suicide cases treated at the JSS hospital in Ganiyari. She was brought to the hospital on a motorbike. After stabalising her, the JSS doctors admitted her to the ICU at the large government hospital in Bilaspur, 25km away. The woman survived thanks to the efforts of the JSS and was discharged from hospital one week later. ..The JSS (Jan Swasthya Sahyog or People's Health Support Group) is a public-health initiative established in 1996 by a handful of committed doctors all of whom trained at elite medical schools in India. While many of their peers secured high profile, high earning posts in premier hospitals in India, the US and the UK, the doctors at JSS have focussed their medical expertise on providing a service for poor and marginalised rural communities in Bilaspur district in the east Indian state of Chhattisgarh. Relying on grants and private donations, the doctors at JSS pay themselves only Rs.20,000 (US$500) a month...The JSS operate out of a hospital in Ganiyari, 25km from the main district town of Bilaspur. The JSS provide a first-class medical service for a community that would otherwise rely on underfunded and poorly resourced government facilities. Though the hospital at Ganiyari boasts 30 beds, two operating theatres, a fully-equipped lab and three outpatient clinics every week, the service provided by JSS is over-subscribed by a community totaling 800,000 people from 1,500 villages. ..To address the malnutrition that is so widespread among the population they serve, the JSS offers training on new agricultural techniques. The JSS has a well established outreach program of village-clinics and employs over 100 village health workers serving 53 villages. The JSS also operates an ambulance service and assists with transport costs for a rural community who's access to essential services has been und (Tom Pietrasik)Empty syringes lie beside the foot of a 30-year old woman experiencing seizures after attempting suicide by drinking insecticide. The woman is one of many such suicide cases treated at the JSS hospital in Ganiyari. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2010

THE PERILS OF STREET PHOTOGRAPHY

Street scene in Lagos...Photo: Tom Pietrasik.Lagos, Nigeria.April 27th 2012 (Tom Pietrasik)Portrait paintings for sale in central Lagos. I found photographing on the streets of Lagos to be quite a challenge. Lagos. Nigeria ©Tom Pietrasik 2012

Wandering around a bus station with my camera on a recent trip to Lagos in Nigeria, I began photographing a newspaper-seller at work but before I’d even pressed the shutter another trader had approached me and angrily accused me of “photographing without permission.”

Such was the indignation directed at me by the small group that quickly gathered, you might imagine that photography in public areas was a crime in Nigeria. I thought it best to apologise and quickly retreat. But the crowd were not ready to accept any expression of regret on my part. A security guard stepped forward and grabbed at my camera. He was quickly joined by another man and the two were able to successfully wrestle the camera from my hand.

Day-wage casual laborers and agents offering employment gather at the Bara Birwa labour post in Lucknow.  Those who are lucky enough to find work can expect to earn Rs.130 to Rs.150 per day. A lack of employment opportunities and caste discrimination that denies people access to land and social secutiy measures fuels labour migration - much of it seasonal - from poor rural areas across Uttar Pradesh - and beyond - to cities like Lucknow. Many of these migrants end up undertaking poor-paying and insecure work on construction sites in cities like lucknow.  ..Photo: Tom Pietrasik.Lucknow, Uttar Pradesh. India.March 3rd 2011. (Tom Pietrasik)I’ve found most Indians to be very generous or completely nonchalant when it comes to being photographed. Day-wage casual labourers and agents offering employment gather at a labour post in Lucknow. A lack of employment opportunities, inequitable land distribution and poor social security measures fuels labour migration in India. Lucknow, Uttar Pradesh. India ©Tom Pietrasik 2011

I don’t often find myself in such awkward situations. My experience of photographing in India, where I lived for ten years, has been almost entirely positive. I’ve found people there to be either incredibly generous or completely nonchalant when it comes to being photographed. But as the crowd in Lagos swelled around me, I was reminded of an incident in 2007 when photographing for the Financial Times magazine in a middle class grocery shop in New Delhi.

I’d been commissioned to illustrate the subject of rising food prices and a shop-owner had kindly granted me permission to take pictures of his customers doing their shopping. I’d been taking photographs in the food-aisles for about 20 minutes when I pointed my camera in the direction of a middle-aged woman at the checkout. Her sudden objection to my “clicking her picture” was so fierce that she accused me of being a pornographer. I could not imagine a scene less titillating than this particular woman bagging her shopping but so apparently compelling was her allegation that other shoppers were convinced there must be some merit to her outrage.

Even the shop owner climbed on board, motivated less by moral indignation than the potential loss of patronage that this rapidly deteriorating situation might cause him. A security guard was ordered to lock me in the shop so that the woman’s husband could be summoned to mete out a little justice.

On his arrival – and much to my relief – the husband avoided physical confrontation and instead satisfied himself with a bit of macho posturing. As he shouted abuse in my face, he scanned through the images on my camera in a vain attempt to find a single photograph that could be described as pornographic.

Life in and around the old market areas of Chandni Chowk in Delhi. ..Photo: Tom Pietrasik.New Delhi.January 2011 (Tom Pietrasik)Street hawkers sell balloons for tourists along Old Delhi’s Chandni Chowk. Delhi. India ©Tom Pietrasik 2011

For those bystanders who had observed my intimidation in Delhi and in Lagos, I discovered that the vast majority were convinced that I must be in the wrong. Most had not actually witnessed the incident in question, nor had they bothered to enquire as to what my motivation might be for taking photographs. It seemed their judgement was arrived at simply on the basis of who was shouting the loudest.

So it was with the support of an ignorant crowd that the angry Delhi shopper and her husband proceeded to remove the flash card from my camera and ceremoniously crush it with a rock. Thankfully, my experience in Lagos culminated in a less destructive outcome. My driver Jimoh came to the rescue and used his powers of persuasion to successfully retrieve my camera before the two of us rushed back to his car.

A scene outside a new house in Bokhra Kachar...The village of Bokhra Kachar, is home to 66 households from the adivasi (tribal) Baiga community. Displaced by the government to make way for the Achanak Marg tiger reserve, this community were forced to move from their old village 27km away two years ago. They were promised compensation, specifcaly each male over age of 18 would receive Rs.100,000, a proper house with toilet, and land at least equivalent in size to what they farmed before, access to PDS (Public Distribution System) and schools. Many families complain that their new land is significantly less fertile than the forest areas they used to farm so where they once went hungry for two lean months in the year, this period has now been extended to three months. Most of Bokhra Kachar's residents have only received Rs.50,000 in compensation and their new homes do not have toilets as promised. Though there is a local primary school, older children have to travel 8km. The nearest PDS is 5km away. There is no local public transport system. Men complain that there is little work in the new village...Photo: Tom Pietrasik.Bokhra Kachar, Lormi Block, Bilaspur District, Chhattisgarh. India.February 18th 2011 (Tom Pietrasik)One of the 66 adivasi (tribal) Baiga households in the village of Bokhra Kachar who were displaced by the government to make way for the Achanak Marg tiger reserve in Chhattisgarh. Bilaspur District, Chhattisgarh. India ©Tom Pietrasik 2011

Because photographers do have the potential to exploit subjects, I would never photograph someone who asked not to be photographed unless there were a greater cause at stake. Indeed, I think it is vital that we respect those we are photographing. But that does not mean photographers need to seek consent every time they point a camera in someone’s direction. In many countries the right to photograph in public is upheld by the law. For example in the US, as David Weintraub explains,

The First Amendment gives photographers and videographers almost unlimited freedom to make images in public places… Anyone appearing in public has given up what lawyers call “a reasonable expectation of privacy.” It doesn’t matter whether they are central to your image or incidental.

But such protection doesn’t meant that photographers escape suspicion when they work in public places. Even in apparently free societies, photographers do suffer shocking violations of their rights, often by the very same people who are enlisted to uphold those rights. And in democratic societies institutions continue to reinforce a mistrust of photographers. Earlier this month for example, Strathclyde Partnership for Transport banned photography on the Glasgow subway system to ensure “any such activity does not disrupt the operations of the network in any way.”

London scenes...Photo: Tom Pietrasik.London, U.K..May 2011 (Tom Pietrasik)A couple enjoy an evening drink at a bar in central London. UK ©Tom Pietrasik 2011

It would be wrong to suggest photography is a necessarily perilous pursuit. Thanks to the ubiquity of cameras in mobile phones, photographers can derive some comfort from our strength in numbers. But there is a collective responsibility we all share – photographers and non-photographers alike – to protect press freedom and recognise that photography has a unique ability to bear witness and enhance our understanding of events. It is worth remembering the positive contribution photography has made to many societies. Attorney Bert Krage reminds us that in the US,

…unrestricted photography by private citizens has played an integral role in protecting the freedom, security, and well-being of all Americans. Photography in the United States has an established history of contributing to improvements in civil rights, curbing abusive child labor practices, and providing important information to crime investigators.

Even if photographs do not directly address a wrong, just think of the myriad of photographs that would be sacrificed were we restrict the right to use a camera in public: photographs that are revelatory, celebrate life or offer critical insight into a given situation. It is worth asking who will provide a photographic record of our history if it isn’t people wielding cameras? Commenting on street photographers, Sophie Howarth and Stephen McLaren remind us that,

At a time when fewer and fewer of the images we see are honest representations of real life, their work is more vital than ever.

I think most people do recognise the merit of photographs and photographers. But it is worth highlighting the value of photography at a time when over-zealous authorities continue to criminalise the act of photographing and in doing so establish a climate of suspicion directed at photographers. The work of groups like iN Public, I’m a Photographer Not a Terrorist and Photography is Not a Crime celebrate photography and advocate for the rights of photographers.

What a loss it would be to all of us if photographers like Henri Cartier Bresson, Fred Herzog or Alex Webb or had been deterred from capturing scenes like this or this or this.

Though the residents of Yashwant Nagar in the Bandra suburb of Mumbai live in a congested neighborhood, they enjoy security of tenure and benefit from a strong civic sense - the result of a long-established community living in the area. Yashwant Nagar is about to be demolished to make way for a new housing development that will accomodate exisitng residents. The municipal water supply in Yashwant Nagar is confined to a few hours in the early morning during which residents must collect and store water for all their daily needs...The BMC (Brihanmumbai Municipal Corporation) uses the UNDP-devised Human Development Index (HDI) as a measure by which to allocate resources. ..Using parameters like population, literacy rate and infant mortality, and ranking wards in the order of performance, the BMC apportions funds to areas with lower education and higher mortality rates. The BMC also encourages the participation of Mumbai's citizens in the monitoring of education and health projects...Photo: Tom Pietrasik.Mumbai, India.September 8th 2010 (Tom Pietrasik)Though the residents of Yashwant Nagar in the Bandra suburb of Mumbai live in a congested neighborhood, they enjoy security of tenure and benefit from a strong civic sense – the result of a long-established community living in the area. Mumbai. India ©Tom Pietrasik 2010